St. Maarten / By Hilbert Haar – “The focus has to be on patient care.” Mental Health Foundation Director Eileen Healy does not want to create another healthcare controversy. Instead she told us about the things that do work in the cooperation between different care institutions and other entities, and a little bit about the pain points that need to be addressed.

On the plus side, Healy says, the informal collaboration with Turning Point, but also with the House of Detention, is working just fine. “Every week, and sometimes twice a week, we are at Pointe Blanche. What we miss there is a forensic observation department like the House of Detention has in Curacao.”

The Mental health foundation has a contract with the House of Detention. When the staff or Dr. Mercuur notes that an inmate needs mental care, he reports this to the MHF. “We have also agreed that these clients, before their release, have a valid ID-card and health insurance. This is the result of cooperation with the department of Social Affairs and the Rehabilitation Bureau; the House of Detention makes the contact with the census office for the ID-card.”

This setup ensures that clients do not end up uninsured on the streets after their release.

Healy dismisses stories often told by attorneys in court that the Mental Health Foundation does not treat clients with a double diagnosis – those who have mental health problems in combination with an addiction to alcohol or drugs. “We do double-trouble cases,” she emphasizes.

The MHF is more than a care institution. “We have four clients on the payroll and we are looking for cooperation with businesses to see if it is possible to employ people there under supervision,” the director says.

The MHF has on staff four social-psychiatric nurses, four regular nurses, two psychiatrists and a psychologist. The MHF has a total of 34 staff.

One of the important missions the MHF has taken on is ambulant are. “We look up patients who do not show up for an appointment to take their medication,” Healy says.

And what about the cooperation with Turning Point? “We want a formal cooperation, but in practice we work together informally. We have never had a problem with each other.”

The MHF is waiting for a decree from the government to establish itself officially as a mental care institution. “In the court case it was claimed that we had not made a formal request for it,” the director says. “But we are working on this already from 2010. The ministry has no procedures, so it is not capable to explain how this needs to be done.”

Healy says that she is looking forward to working together with other institutions and with the ministry. “Let us work together, but give us the tools to do our job,” she says. “Start with standards for patient care.”

That St. Maarten needs a mental healthcare institution is beyond discussion. The Mental Health foundation serves 600 out-patient clients. “You won’t ever realize that they are there,” Healy says. “Medication is so refined these days that you are able to achieve a lot with very little medication.”

Most of these clients have the support of their families. “Between 80 and 85 percent of our clients live at home. The families are taking care of their relatives with a psychiatric disorder. This way, mental healthcare is still relatively cheap in St. Maarten.”

The foundation’s clinic in Cay Hill was officially opened by H.M Queen Beatrix in the company of Crown Prince Willem Alexander and Princess Máxima. But since that festive opening, the clinic did not get the full support from the government.

But the MHF-director refuses to focus on the negative. “If the minister says that we have to collaborate with others, I say: I am not against that. It is about patient care.”

The foundation works together with the White and Yellow Cross – among others by making a psychiatrist available for 10 hours per week – and there is also cooperation with the BES-islands. The collaboration with Turning Point is on an informal basis, but it works. The MHF works in crisis situations also well together with the police. Only with the St. Maarten Medical Center there is no cooperation, according to Healy because Director George Scot “does not work together with institutions, only with natural persons.”

“This way the care remains fragmented,” she says. We need top-down coordination. But in the meantime the informal collaboration functions very well.”

The foundation provides seven forms of care. The out-patient clinic serves 600 clients; due to the crisis-intervention service no client has ever been flown out to Curacao anymore. The clinic in Cay Hill also admits clients in a closed wing (involuntary admission), and it provides assisted living facilities where clients are prepared for a return to society. Other services are the ambulant care, the Faraja center that offers day programs, and an information and prevention department.